Ingrid Bergman was one of the best actresses ever. She won three Academy Awards, two Emmys, four Golden Globes and a Tony Award for Best Actress. Many of her more than 50 films are among the most popular films of all time: Intermezzo (1939), Casablanca (1942), Notorious (1946), For Whom the Bell Tolls (1950), Spellbound (1950) and Anastasia (1956). She continued to work for nine years after receiving a diagnosis of breast cancer, before dying of it at age 67.

We have no idea what caused her breast cancer, but her lifestyle included many risk factors. I have not seen her medical records so I do not know if her body produced excess estrogen, if she took estrogen or if she was genetically more sensitive to estrogen. However, she was known to drink a lot of alcohol, did not exercise, smoked heavily and probably did not have a very healthful diet. She said, "When I first came to New York, I ate four ice creams a day." Biographer Laurence Leamer called her "a hard-drinking, hard-smoking woman."

Early Start in Films
She was born in Stockholm in 1915, to a Swedish father and his German wife. Her mother died when she was two and her father died when she was 13. She was sent to live with an aunt who died six months later. She then went to live with another aunt and uncle who already had five other children. She was told that her mother was Jewish, but not to tell anyone because difficult times were coming. At age 17 she won a scholarship to the Royal Dramatic Theater School and got a job with a Swedish film studio.

She had a lot to prove and she outworked everybody else. She learned to speak five languages fluently and was able to act in roles speaking Swedish, German, English, Italian and French. In 1935, at age 20, she was hired by a Swedish film company and made more than a dozen films. When she was 21 she married a dentist named Petter Aron Lindstrom and they had a daughter, Friedel Pia Lindstrom, who became a television news reporter in New York City.

In 1939 at age 24, she got a job in the United States. She took a chance by accepting Hollywood producer David O. Selznick's offer for her to star in Intermezzo, and left her husband and daughter in Sweden. Selznick had a lot of concerns:
• she didn't speak English,
• at 5' 9", she was taller than most of the male actors,
• her name sounded too German, and
• her eyebrows were too thick."
However, he told friends and reporters that, "Miss Bergman is the most completely conscientious actress with whom I have ever worked, in that she thinks of absolutely nothing but her work before and during the time she is doing a picture . She practically never leaves the studio, and even suggested that her dressing room be equipped so that she could live here during the picture. She never for a minute suggests quitting at six o'clock or anything of the kind. Our star dressing-room suites were all occupied and we had to assign her a smaller suite. She went into ecstasies over it and said she had never had such a suite in her life." Intermezzo was a huge success.

Marriages Are Often Destroyed by Separations
In 1941, her husband came from Sweden to the United States with their daughter. While Ingrid made pictures elsewhere, he stayed in Rochester, New York to make the transition from dentist to medical doctor at the University of Rochester. On the rare occasions that she was not making films, Ingrid would visit him in his tiny rented house in Rochester. He then moved to San Francisco to serve his internship, and she visited him there between films. Meanwhile, she had an affair with Gregory Peck while they were making Spellbound. In 1942, she starred in her most famous movie, Casablanca, with Humphrey Bogart.

In 1949, she wrote a letter to Italian director Roberto Rossellini, asking to star in one of his films. He hired her for Stromboli and at age 35, she began an affair with Rossellini. She was still married to Petter Lindstrom and Rossellini was also married, but separated. She became pregnant and moralists around the world were appalled. It did not matter that both were in very unhappy marriages and were not living with their spouses. Senator Edwin C. Johnson of Colorado criticized her in the U.S. Senate as "a powerful influence for evil." Ed Sullivan refused to have her on his show.

Outrage in the United States was so severe that she stayed in Italy, where she gave birth to Roberto Ingmar Rossellini on February 2, 1950. The next week she divorced Lindström and married Rossellini in Mexico. Two years later, she gave birth to twin daughters. She made five more movies with Rossellini between 1950 and 1955. In 1956, she returned to America to star in Anastasia, and in 1957 she divorced Rossellini. In 1958, she married Lars Schmidt, from a wealthy Swedish shipping family. In 1972, Senator Charles Percy wrote an apology into the Congressional Record for Senator Johnson's criticism of her 22 years earlier. In 1975, she divorced Lars Schmidt and continued to make block-buster films even though she had been diagnosed with breast cancer.

In 1982, at age 66, she starred in a television miniseries, A Woman Called Golda, even though she was riddled with metastatic breast cancer. She won both Emmy and Golden Globe awards for her portrayal of Israeli Prime Minister Golda Meir. Four months after the filming, she lost her nine-year battle with cancer and died on her 67th birthday.

Risk Factors for Breast Cancer
We do not know what really causes breast cancer. The strongest evidence we have is that anything that increases or prolongs estrogen exposure is associated with risk for breast cancer:
• Starting menstruation before age 11
• Stopping menstruation (menopause) after age 52
• Taking estrogen (estrogen plus progesterone may be an even stronger stimulant)
• Not having a baby until after age 30
• Using oral contraceptives (risk declines a few years after stopping the pills)
• Injectable birth control progesterone (risk decreases after you stop taking it)

Other Exposures and Habits Associated with Increased Risk for Breast Cancer
• Exposure to chemicals that act like estrogen: some plastics, certain cosmetics and cosmetic products, pesticides, polychlorinated biphenyls (BPH)
• Drinking alcohol. At any amount, alcohol appears to increase risk for breast cancer, and the more you drink, the greater the risk
• Being overweight, possibly because fat cells make estrogen or because excess weight raises blood insulin levels, both associated with increased risk for breast cancer
• Gaining weight after adolescence: women who are thin as teens and overweight as adults are at higher risk for breast cancer than those who were always heavy
• Storing fat primarily in the belly rather than in hips and thighs. People who store fat primarily in the belly also store fat in the liver which increases insulin levels, and high insulin levels increase risk for breast cancer risk.
• Diabetes
• Lack of exercise. In one study, just 1.25 to 2.5 hours per week of brisk walking reduced breast cancer risk by 18 percent (Control Clinical Trials, 2002;23:728-756)
• Tobacco smoke, including second-hand and third-hand smoke
• Not having children (the more children, the lower the risk)
• Having a first child after age 30
• Not breast-feeding (breast feeding reduces the number of menstrual cycles)

Still-Debatable Risk Factors
• Vitamins: some studies show increased risk for breast cancer in women with higher levels of certain vitamins. No studies have shown that taking vitamins helps to prevent breast cancer.
• Diets high in red meat, processed meats or fried foods have been associated with increased risk for breast cancer.
• Not eating lots of fruits and vegetables. A plant-based Mediterranean-type diet is associated with reduced risk for breast cancer (JAMA Internal Medicine, September 14, 2015 and American Journal of Clinical Nutrition, 11/30/2015).
• Night shift work.
• Use of fertility drugs that cause very high estrogen levels.

About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities.
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